REACHING PARTS MEDICAL EDUCATION DOESNT REACH INNOVATIVE APPROACHES IN CLINICAL EDUCATION USING VIRTUAL PATIENTS Jonathan Round, Alex Higton, Terry Poulton

What do Virtual Patients do well? Take you to places you cant or shouldnt go Risk free practice Deliver standardised experience in a (virtually) real way

3 models extending VPs The virtual ward round The virtual clinic The multi-professional virtual patient Error patient

Virtual Ward Round Whats missing Rationale Design Resources Feedback

Virtual Ward Round Whats missing…ward savvy, ward nouse, the clinical process Rationale…online delivery of a weeks ward action Design…html, frames driven, multiple linear, control over information Resources…internet connection, projector, facilitator Feedback

Virtual Ward Round Context MondayRegistration Ethics in Paediatrics Neonatology 1 Neonatology 2 Intro and Virtual Ward Round Day 1 Paediatric Endocrinology 1 TuesdayGenetics Nutrition and Growth Chronic Paediatric Neurology/ Development Paediatric Endocrinology 2 Virtual Ward Round Day 2 Wednesday Child Psychiatry 1 Child Psychiatry 2 Paediatric Surgery Virtual Ward Round Day 3 ThursdayPaediatric Gastroenterology Acute Paediatric Neurology Child Safeguarding Oncology Images in Paediatrics Virtual Ward Round Day 4 Friday Respiratory Paediatrics Paediatric Cardiology Virtual Ward Round Day 5 Common Paediatrics Infections Course structure

VWR Aims… EXPOSURE UNMASKING THE CLINICAL PROCESS REAL PROBLEMS WARD WISDOM ENGAGING FEASIBLE

Challenges… CONCEPT LAYOUT PROGRAMMING CASE WRITING DELIVERY

Tools used…

Site Architecture… MondayFridayThursdayTuesdayWednesday Bed 3 Bed 1 Bed 2 Bed 4 Bed 3 Bed 1 Bed 2 Bed 4 Bed 3 Bed 1 Bed 2 Bed 4 Bed 3 Bed 1 Bed 2 Bed 4 Bed 3 Bed 1 Bed 2 Bed 4

Site Architecture… MondayFridayThursdayTuesdayWednesday Bed 3 Bed 1 Bed 2 Bed 4 Developments History Examination Investigations Fluids Treatment Developments History Examination Investigations Fluids Treatment Developments History Examination Investigations Fluids Treatment Developments History Examination Investigations Fluids Treatment

VWR ratings Likert scale Most valuable session 221 students, 6 rotations

Feedback

Comments…Strengths The virtual ward round may be less cases, but to go through them in more detail. Virtual Ward Round is a great idea, but feels a bit much and 30 mins is not enough time. I loved the Virtual WR. Virtual ward round gave us an insight into the management of different conditions. The Virtual WR were good at bringing all topics together and making you think. Virtual ER - management of common problems and what happens in real life.

Comments…Weaknesses Virtual Ward Rounds at the start of the day. I was exhausted and brain dead by the time the Virtual Ward Round came around. Maybe do it in the morning! Less (maybe 3) Virtual WR patients or longer time. Virtual WR is helpful but too many patients.

Virtual Clinic Whats missing…multiple sequential clinical related challenges Rationale…prepare students, expose students to a mornings work. consolidation of learning Design…decision simulation, linear/branched Resources…individual or small group learning, internet connection Feedback…

Comments - Strengths Really good Please provide more to medical schools very useful excersize Excellent resource - promote Allowed numerous cases to be explored at once in quick succession Good to be given numerous clinical scenarios Complements PBL You get to think like a doctor Choices within vignettes allow clinical reasoning Brought it to life – nice to do PBL process on my own.

Comments - weaknesses Guidance needed on … CXR intrepretation…UEC values Wheres the back button? Id like to review CXRs later in the case Id like to explore different outcomes Doesnt tell you the idea path, cant be bothered to do it again Too long to complete.

Multiprofessional Virtual Patient Whats missing...seeing patients from another angle, integrated care, teamwork Rationale…expose students to same VP, but from different angles, allow to switch Design…multitrack VP, with crossover points and joint meetings. Decisionsimulation/labyrinth Resources…individual/small group, internet enabled computer Feedback

Error Virtual Patient Whats missing…learning from past mistakes Rationale…professionals make the same mistakes over and over and over again Design…branched VP Resources…decision sim, for asynchronous or group work Feedback

Timeline Nov 2009

Error feedback

anticipation of difficultiesdifferentinterestingrealisticthought provoking can we have anotherengaginginterestingrealisticthought provoking challengingenjoyableinterestingrealisticthought provoking challengingfamiliarinterestingrealisticuseful challengingfrighteningirresoluterealisticuseful challengingfunprioritisingrealisticuseful challenginghelpfulprioritisingrealisticutilisation of personel challenginghelpfulrealisticrelevant challenginginformativerealisticscary complicatedinformativerealisticscary Standing up to someone who is more specialised than you is difficult and scary but sometimes it needs doing and is an important thing to learn how to do Adjectives What will I take away

Conclusions Many situations where typical VP may not be mimic clinical reality Adaptions to VP model stretch reach of the virtual patient Students challenged and appreciative of new designs app.decisionsimulation.com Chest Clinic Lauren Brook Errol Rouch